Care Manager RN Hybrid

Description

The Care Manager RN supports the patient and primary care relationship through care delivery enhancement. This role is primarily work from home with 1-2 days a week in the Salt Lake City office and ability to visit the practices in the area as needed. Primary mechanisms for this support are telephonic outreach to patients to guide them through transitions of care, care management, preventive services, and self-management.

The Care Manager acts as an integral member of the division Care Coordination team supporting Physician Services primary care providers and practices in successfully meeting quality improvement initiatives in assigned division(s).

• Serves as a subject matter expert in quality and value-based care programs such as MIPS, ACOs, and payor pay-for-performance contracts. Assists in educating practice staff on quality, payor, and government program requirements
• Develops professional working relationship with HCA/PSG primary care providers, practice managers, and their staff to collaboratively manage follow-up care and improve overall health and wellness
• Attends learning sessions and shares information learned with team members
• Assists in the development of tools, education and workflow processes to assist the division(s) in meeting CMS, ACO, documentation, and payor quality initiatives
• Collaborates with interdisciplinary teams and leaders (PSG, Payer Contracting & Alignment, Quality and Payor Initiatives) to achieve the organization’s coordination of care goals, quality goals, and financial performance goals
• Conducts in-person and virtual meetings with practice managers, staff, providers and managers to communicate program goals, results, and provide education
• Maintains the strictest confidentiality in the areas of patient, employee, and physician relations
• Practices and adheres to the “Code of Conduct” philosophy and “Mission and Value Statement”
• Acts as a patient advocate to facilitate appropriate care management and wellness activities
• Performs related work and additional duties as requested by supervisor

• Monitors patient compliance with preventive screening and/or behavioral health management processes using internal and payor reporting tools
• Accesses portals as necessary to prepare reports and other documents to evaluate progress and prioritize workload
• Communicates via telephone and other virtual tools with patients regarding care needs, documenting communications appropriately in the electronic medical record
• Prepares and maintains patient charting as needed and performs medical record reviews for payor projects

• Contacts patients after hospital discharge to identify the need for a follow-up appointment, community resource needs, etc.
• Documents assessment in the medical record to support transition of care services as specified by CMS and other program requirements

• Uses available tools to identify at-risk patients
• Triages patients to determine those appropriate for medical and/or behavioral care management
• Creates a care management action plan with the patient/caregiver that includes elements of self-management, as appropriate
• Identifies and enrolls eligible patients in longitudinal or chronic care management for medical or behavioral health conditions
• Oversees the execution of patient care plans in partnership with Care Coordinators
• Facilitates specialty referrals, as appropriate, for conditions/needs managed outside the primary care realm
• Documents efforts in accordance with established workflow protocols
• Identifies and engages community resources to assist patients as needed

• Assists with practice and provider empanelment processes
• Schedules appointments related to preventive care, chronic disease management, and/or integrated behavioral health
• Prepares and maintains care coordination reports and provides periodic updates to practice leaders and providers
• Conducts wellness campaigns for targeted, focus areas

• Knowledge of value based care and care management experience.
• Active RN License required.

HCA Healthcare offers a total rewards package that supports the health,…